the system would weaken the perception of therapeutic aura or respect traditionally bestowed on physicians. This could lower the esteem given them by the patients for whom a prescription drug might work as a placebo. Finally, some GPs were concerned about a cultural change in their practices due to innovation, their own initiative, and experimentation to mere compliance with external standards imposed by government administrators.

Resisting and supporting groups. The Ministry and the insurance companies strongly encouraged GPs to adopt and use the system. The College of General Practitioners was supportive though less strongly than other groups. The representative group of patients interviewed shared the GPs’ concerns about the system, while other stakeholder groups did not strongly resist EPS diffusion.

This case study illustrates how we
could have misunderstood 52% of the
GPs interviewed if we had taken a one-
dimensional view—acceptance ver-
sus resistance. Moreover, two groups
within the quadrant labeled “resisting
but high usage” showed user reactions
are a matter of degree. Implementers
should take this into account when de-
veloping their strategies.

Promoting adoption

Here, we assume IS implementers aim to move all users into the supporting-and-high-usage group. In discussing strategies, we focus on the two groups of interviewed GPs with ambivalent behaviors: “resisting but high usage” and “supporting but no/low usage” (see Figure 3):

Resisting but high usage. This ambivalent behavior deserves attention because it is part of an organization’s shadow system, with significant influence on overall organizational performance. Though users showing this behavior are considered high usage, it is likely they are forced to use the system, as with 20% of the GPs. In other cases, some people might use a system because they opportunistically experience it as the most convenient option, as 18% of the GPs said they did. These two groups should be treated differently. Users from the 20% group were usually

figure 3. strategies for promoting is adoption, by group.

( 1) Resisting but high usage
( 2) supporting and high usage

high Usage for users

i) Cultural resistance;
building dialogue.
ii) Fear of losing power
and autonomy; negotiation
iii) Fear of uncertainty;
clear explanation
i) Ask people reasons for supporting
and using IS, then apply answers
to retain them.

 

( 4) Resisting and No/Low usage
( 3) supporting but No/Low usage

no/Low Usage

i) Moving people to the group
of supporting-and-high-usage
users requires resources
and time (risky).
ii) First moving people to the group
of supporting-but-no/low-usage
is recommended with these
strategies.→↑
iii) First trying to force people to
the group of resisting-but-high-
usage users. ↑→

i) Inspire support by asking about
technology-related issues to
improve the system.
ii) technical barrier; training
and tech-support desks.
iii) High sunk and switching costs;
support people, including
through financial subsidies,
to decrease these costs.

Resisting
neutral
Supporting

for other actors
Resisting Group
supporting Group

Find mutual benefit and common goals while minimizing political conflict.

Build a coalition with these actors,
informing them of adoption
progress and working together
to solve non-technological problems.

experienced older GPs participating in group practices who felt using the system would go against professional norms valuing personal relationships with patients. They also feared losing autonomy as traditional doctors. Moreover, their concerns were ignored, even as they felt managerial or peer pressure to use the system. To address these concerns, we suggest the following:

Cultural resistance. Potential users can view a system as incompatible with their personal or organizational norms and values. Implementers should thus engage in a dialogue with them to understand those values, explain how the system does not violate them, and cooperate in modifying the system to uphold them; and

Fear of losing autonomy. Implementers should determine whether concerns about losing autonomy are substantial and legitimate or unfounded. If legitimate, the implementers should negotiate with potential users to achieve a win-win scenario through compensation and other methods. If unfounded, the implementers should do their best to reassure the users they have nothing to fear.

The interviewed GPs from the 18% group were predominantly less-ex-perienced young doctors participating in group practices, feeling under-informed about the consequences of adopting the system, so used it conservatively to obtain a second opinion:

Uncertainty. Anyone can fear and resist a system when ignorant of the consequences of its use. Implementers should explain its purpose and implementation process so the intended users anticipate the changes likely to occur.

Supporting and high usage. Retaining “supporting and high usage” users is as important as attracting users from other groups. Implementers can gather, analyze, and apply the reasons to retain users in this group and attract others from other groups. For example, many young urban GPs from group practices were in this category, believing their use of the EPS made them more professional while increasing medical quality and consistency. Implementers can encourage users in such a group to be advocates by, say, inviting the supporting-and-high-usage GPs to discuss and share their positive experience with the passively resisting-